China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China.
Health Policy Plan. 2022 Nov 14;37(10):1307-1316. doi: 10.1093/heapol/czac073.
China's public hospital price change reform was progressively piloted at urban-level tertiary hospitals in 2015, aiming to adjust the healthcare expenditure structure, reorient public hospitals towards social objectives and control inflated healthcare expenditure. This study investigates the impacts of price changes on inpatient expenditure, service quantity, quality and efficiency and whether the impacts varied in different specialities, treatments and hospitals. A difference-in-differences analysis was conducted using data from 25 million patients from 124 nationally representative tertiary hospitals between 2013 and 2018. The study analyses changes in total expenditure, drug, medical services and diagnostic test/medical consumables expenditure per admission, the use of antibiotics, performed surgery, readmission within 30 days and length of stay (LOS). These factors are examined before and after adjusting the price changes for demographic, socioeconomic and clinical covariates. The price changes decreased drug expenditure per admission (-13.5%, P < 0.001, USD 96.6) and increased medical services expenditure per admission (30.9%, P < 0.001, USD 153.3). They also reduced the LOS (-1.2%, P = 0.019, 0.1 days) while not significantly affecting total expenditure per admission, diagnostic test/medical consumables per admission and the use of antibiotics, surgery performed and readmission rates. In heterogeneity analysis, price changes reform increased efficiency in major diagnostic categories (MDCs) with high drug share and improved quality in nonoperating room surgical groups and hospitals with high drug share; however, it increased total expenditure in MDCs with low drug share or surgical groups. China's public hospital price change reform generally adjusted the inpatient expenditure structure and reduced the LOS in tertiary public hospitals. Sufficient compensation from medical services and government subsidies that minimize the income effects may be the key to the success of price change reform.
中国的公立医院价格改革于 2015 年在城市三级医院逐步试点，旨在调整医疗支出结构，使公立医院回归社会目标，控制医疗费用膨胀。本研究调查了价格变化对住院患者支出、服务量、质量和效率的影响，以及这些影响在不同科室、治疗和医院是否存在差异。利用 2013 年至 2018 年来自全国 124 家三级医院的 2500 万患者的数据，采用双重差分分析方法进行了研究。该研究分析了每次住院的总支出、药物、医疗服务和诊断测试/医疗耗材支出、抗生素使用、手术、30 天内再入院和住院时间（LOS）的变化。这些因素在调整人口统计学、社会经济和临床协变量的价格变化前后进行了检查。价格变化降低了每次住院的药物支出（-13.5%，P<0.001，96.6 美元），增加了每次住院的医疗服务支出（30.9%，P<0.001，153.3 美元）。它们还降低了 LOS（-1.2%，P=0.019，0.1 天），而对每次住院的总支出、每次住院的诊断测试/医疗耗材支出以及抗生素使用、手术和再入院率没有显著影响。在异质性分析中，价格变化改革提高了药物使用比例高的主要诊断类别（MDC）的效率，提高了非手术室手术组和药物使用比例高的医院的质量；然而，它增加了药物使用比例低的 MDC 或手术组的总支出。中国的公立医院价格改革总体上调整了三级公立医院的住院患者支出结构，并降低了 LOS。医疗服务的充分补偿和政府补贴，以最小化收入效应，可能是价格改革成功的关键。
